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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205.(209)468-3420 <br /> I � <br /> NON-REFUNDABLE PERMIT r CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> �^ <br /> Joe ADDRESS ] n L], 1 �(1 CITYIZIP Fee✓1 L Ca M1.0 115- 3 I <br /> CROSS STREET I rr6 f ( w4-I APN I q j - 3 Zo - 1(0 PARCEL SIZE ` 7 <br /> OWNER NAME /��1` PHONE <br /> r� A� / <br /> OWNER ADDRESS <br /> II G S D O4 - /- CITYISTATFJZIP F-.-e tC1, (4t*t� �C/7 l`I SZ31. <br /> CONTRACTOR 1 1I D, Sen A.P ( Jt CI 'JeS /! ����A DO�^ W, PHONE `�0 /) -3(.-7j701 <br /> CONTRACTOR ADDRESS dj C� �Qt15+/''j4I 0 /�CITYISTATERIP I CN /5Sz o <br /> LICENSE C-42 C-36 OTHER �-5- I NUMBER tom( EXPIRATION DATE � / ( -7 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> I PERC TESTM 1 BUILDING PERMIT S LAND USE APPLICATION S /�-- 3 �o6 - <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OFSERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: I RESIDENCE I I COMMERCIAL I OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE�,MFG CAPACITY gal M OF COMPARTMENTS_ <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal R o COIAPART*,IeaTs_ <br /> DISTANCE TO NEAREST: WELL It FOUNDATION f; PF:PERTI'LAN P. <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS IF OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH It LENGTH ft DEPTH fl <br /> DISTANCE TO NEAREST WELL R FOUNDATION It PROPERTY LINE it <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE It <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL fl FOUNDATION It PROPERTY LINE it <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMBER WIDTH it DEPTH R <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE WS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIM 4 N T10E REQUIRED FOR INSPECTION -PLEASE CALL 209 953-7697 <br /> SIGNED TITLE 5 e DATE 2 ( _ <br /> I <br /> CE VEA <br /> T <br /> 242o, <br /> Pius UIN CO <br /> 10'WEIV. UN7y <br /> I <br /> PANTMENT <br /> i <br /> I <br /> I <br /> P R �)/ <br /> Application Accepted By Date_ `� Area --�i==F-- Employee 11301 <br /> Final Inspection By �!Z Dete SPECIAL PERMIT-Approved by <br /> Characcttiller of Soil to Delfth of 3 Ft: ir: 1 P11,4ump Soil Character: <br /> COp LENTS <br /> PESC Received. _Ch Amount Date Permit/ Invoice M Permit IDM <br /> Code INFO ash Remitted Service R uest M <br /> z2�J I 3 1 c.c X2�/r <br /> 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 42412 <br />